The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors

Abstract

BACKGROUND: For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorshipspecific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]). METHODS: From April to August 2020, cancer survivors with insomnia (N = 10) were interviewed to refine SSP content and delivery. From October 2020 to March 2021, 40 survivors were recruited for a randomized controlled trial comparing 4 weekly SSP sessions with enhanced usual care (EUC) (CBT-I referral plus a sleep hygiene handout). Feasibility and acceptability were assessed by enrollment, retention, attendance, fidelity, survey ratings, and exit interviews. Insomnia severity (secondary outcome), sleep quality, sleep diaries, and fatigue were assessed at baseline, postintervention, and at 1-month follow-up using linear mixed models. RESULTS: The SSP included targeted content and clinician-led, virtual delivery to enhance patient centeredness and access. Benchmarks were met for enrollment (56% enrolled/eligible), retention (SSP, 90%; EUC, 95%), attendance (100%), and fidelity (95%). Compared with EUC, the SSP resulted in large, clinically significant improvements in insomnia severity (Cohen d = 1.19) that were sustained at 1-month follow-up (Cohen d = 1.27). Improvements were observed for all other sleep metrics except sleep diary total sleep time and fatigue. CONCLUSIONS: Synchronous, virtually delivered CBT-I targeted to cancer survivors is feasible, acceptable, and seems to be efficacious for reducing insomnia severity. Further testing in larger and more diverse samples is warranted.

When Cancer Centers Snooze, Patients Lose: It is Time to Make Insomnia a Priority for Survivors

“…Similar work, with similar outcomes, has been conducted at other institutions. 22,23 While fully automated computer interventions are efficacious, treatment completion rates may be an issue 24 ; thus, they are not advised as the sole program offering at the present time. However, as researchers refine and improve user engagement with computer/app-based health interventions, the role of digital insomnia treatment programs as part of survivorship care could increase in the future.…”

Insomnia in Cancer Survivors

“…A noteworthy challenge is to make CBT-I available and accessible to meet cancer survivors’ needs while acknowledging the limitations of traditional healthcare systems, burdened with a growing weight of chronic illnesses. An increasing body of health economic evidence suggests dCBT-I is a cost-effective (Hall et al, 2022) and feasible (Boinon et al, 2021) solution among cancer survivors. Considering this format may lead to lower healthcare costs if made available at scale (e.g., Sampson et al, 2022), the upsurge of iCBT-I for the general population comes as no surprise: in 2020, the FDA approved the first prescription iCBT-I for the USA, and very recently another Internet intervention is being incorporated in some parts of the UK National Health Service (Riemann et al, 2022).…”

Living Your Best Life: Lifestyle Medicine for All Women

“…Sleep disturbance and insomnia are highly prevalent among breast cancer survivors, with rates as high as 30–50%. 54 Multiple factors contribute to insomnia, including side effects from endocrine therapy, discomfort from local therapy, anxiety, and fear of recurrence. Cancer-related insomnia is associated with worsening daytime functioning and quality of life.…”